Plan Name Plan ID Sanford Health Plan 38 · Plan Name Plan ID 38 ... Controlling High Blood Pressure Beta Blocker Treatment after Heart Attack ... 165 120 125 111 116 123 58 162 89

Plan Name Plan ID 38

Reporting Year 2006 Submission # Last Refreshed: 10/7/2009 1:21:32 PM

Page Page2 23 41

24 43

Page 25 44

3 26 45

5 27 48

7 28 51

8 29 54

9 3013

14 3115

16 3217

18 33 67

19 34 71

22

26 Page28 35 75

36 79

37 81

33 38 83

34

38 Page39 39 87

Page

40 91Enrollment by Product Line (Age & Sex)

Outpatient Drug Utilization

Initiation/Engagement of Alcohol & Other Drug Dependence Treatment

Mental Health Utilization - Inpatient Discharges and Average Length of Stay, by Age and Sex

Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services

Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay

Use of Appropriate Medications for People with Asthma

Comprehensive Diabetes Care

Cholesterol Management for Patients with Cardiovascular Conditions

Glaucoma Screening in Older Adults

Effectiveness of Care Measures

Use of Services Measures

Access / Availability of Care Measures

Health Plan Stability Measures

Disclaimers

Childhood Immunization Status

Adolescent Immunization Status

Appropriate Treatment for Children with Upper Respiratory Infection

Colorectal Cancer Screening

Breast Cancer Screening

32

General Info

Cervical Cancer Screening

Chlamydia Screening in Women

Osteoporosis Management in Women Who had a Fracture

Controlling High Blood Pressure

Beta Blocker Treatment after Heart Attack

Persistence of Beta Blocker Treatment After Hearth Attack

Follow-Up Care for Children PrescribedAttention-Deficit/Hyperactivity Disorder (ADHD) Medication

Antidepressant Medication Management

Sanford Health Plan

1

Health Plan Descriptive Information Measures

Annual Monitoring for Patients on Persistent Medications

Drugs to Be Avoided in the Elderly

Potentially Harmful Drug-Disease Interactions in the Elderly

Children's and Adolescents' Access to Primary Care Practitioners

Prenatal and Postpartum Care

Adult's Access to Preventive/Ambulatory Health Services

Inpatient Utilization - General Hospital/Acute Care

Ambulatory Care

Inpatient Utilization - Nonacute Care

Years in Business / Total Membership

57

60

64

Identification of Alcohol and Other Drug Services

Well Child Visits in the First 15 Months of Life

Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life

Adolescent Well-Care Visits

Frequency of Selected Procedures

HEDIS 2007 (Reporting Year 2006) Page 1

DISCLAIMERS

-1

0. Disclaimer Query located below1. In October 2009, it was discoverd that the formulas in the Inpatient Utilization: General

Hospital/Acute Care measure contained error. The formula was fixed and the data displayed now correctly reflects the rest of the data on the sheet.


Effectiveness of Care Sanford Health PlanChildhood Immunization Status Data Last Refreshed:

Oct 7, 2009 1:21 PM

CommercialGeneral Measure

DataDTaP/DT IPV MMR HiB Hepatitis B VZV

Pneumo-coccal

ConjugateCombo 2 Combo 3

2006H

246

45 114 108 123 117 90 69 31 2018.29% 46.34% 43.90% 50.00% 47.56% 36.59% 28.05% 12.60% 8.13%

2460.00%246

45 114 108 123 117 90 69 31 2018.29% 46.34% 43.90% 50.00% 47.56% 36.59% 28.05% 12.60% 8.13%

3

0

0

2

0

24145 114 108 123 117 90 69 31 20165 120 125 111 116 123 58 162 89

87.14% 97.10% 96.68% 97.10% 96.68% 88.38% 52.70% 80.08% 45.23%82.70% 94.77% 94.21% 94.77% 94.21% 84.13% 46.19% 74.83% 38.74%91.57% 99.42% 99.15% 99.42% 99.15% 92.63% 59.21% 85.33% 51.72%Upper 95% Confidence Interval

Numerator Events by Medical RecordReported RateLower 95% Confidence Interval

Number of employee/dependent records excluded

Records Added from the Oversample List

DenominatorNumerator Events by Admin Data

Number of Records Excluded Because of Valid Data Errors

Number of Records Excluded because of Contraindications by Admin Data

Number of Records Excluded because of Contraindications by Medical Record Review

Oversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS

Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample Size

Data Elements

Measurement Year

Eligible Member PopulationData Collection Methodology


Effectiveness of Care Sanford Health PlanChildhood Immunization Status Data Last Refreshed:

Oct 7, 2009 1:21 PM

MedicaidGeneral Measure

DataDTaP/DT IPV MMR HiB Hepatitis B VZV

Pneumo-coccal

ConjugateCombo 2 Combo 3

NR NR NR NR NR NR NR NR NR


NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRUpper 95% Confidence Interval









Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample Size

Data Elements

Data Collection MethodologyEligible Member Population

Measurement Year


Effectiveness of Care Sanford Health PlanAdolescent Immunization Status Data Last Refreshed:

Oct 7, 2009 1:21 PM


DataMMR Hepatitis B VZV Combo 2

2006H

291

33 19 9 211.34% 6.53% 3.09% 0.69%

2910.00%

29133 19 9 2

11.34% 6.53% 3.09% 0.69%

0

0

0

0

0

29133 19 9 2199 125 63 46

79.73% 49.48% 24.74% 16.49%74.93% 43.57% 19.61% 12.06%84.52% 55.40% 29.87% 20.93%

Measurement Year




Upper 95% Confidence Interval





Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS

Currect Year's Administrative RateMinimum Required Sample SizeOversampling Rate

Data Collection MethodologyEligible Member PopulationNumerator events by admin data in eligible population

Data Elements


Effectiveness of Care Sanford Health PlanAdolescent Immunization Status Data Last Refreshed:

Oct 7, 2009 1:21 PM


DataMMR Hepatitis B VZV Combo 2

NR NR NR NR

NR NR NR NR

NR NR NR NRNR NR NR NRNR NR NR NR

Measurement Year

Upper 95% Confidence IntervalLower 95% Confidence Interval




Numerator Events by Medical RecordReported Rate




Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS

Numerator events by admin data in eligible populationCurrect Year's Administrative Rate

Oversampling RateMinimum Required Sample Size

Data Elements



Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM

Appropriate Treatment for Children with Upper Respiratory Infection


Data

2006

A

546

43

92.12%

89.77%

94.48%

Data Elements

Data Collection Methodology

Eligible Member Population

Measurement Year

Numerator Events by Admin Data


Reported Rate

Lower 95% Confidence Interval


Effectiveness of Care Sanford Health PlanColorectal Cancer Screening Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial Medicare Advantage MSHO

2006

A

3737

NR NR NR

NR NR NR

1586

42.44% NR NR

40.84% NR NR

44.04% NR NR

Eligible population

Measurement Year

Data Elements

Data collection methodology (administrative or hybrid)

Oversampling rate

Final sample size (FSS)

Number of numerator events by administrative data in FSS

Number of numerator events by administrative data in eligible population (before exclusions)

Minimum required sample size (MRSS) or other sample size

Numerator events by administrative data

Number of original sample records excluded because of valid data errors

Number of administrative data records excluded

Number of medical record data records excluded

Reported rate

Administrative rate on FSS

Current year's administrative rate (before exclusions)

Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total

Upper 95% confidence interval

Lower 95% confidence interval

Numerator events by medical records

Number of employee/dependent medical records excluded

Records added from the oversample list

Denominator


Effectiveness of CareBreast Cancer Screening

Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM


Data Ages 42-51 Ages 52-69

2006A

1664 1791 34551112 1353 2465

66.83% 75.54% 71.35%64.53% 73.53% 69.82%69.12% 77.56% 72.87%

TotalData Elements


Measurement Year

Reported RateLower 95% Confidence IntervalUpper 95% Confidence Interval





Medicare AdvantageGeneral Measure


NRNR

NR NR NRNR NR NRNR NR NR

TotalData Elements

Measurement YearData Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval




MSHOGeneral Measure


NRNR


TotalData Elements

Measurement YearData Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval






NRNR


Total

Numerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval

Data Elements

Measurement YearData Collection MethodologyEligible Member Population


Effectiveness of Care Sanford Health PlanCervical Cancer Screening Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial Medicaid2006

A3957

78.59% NR

NR NR

3110

78.59% NR77.30% NR79.89% NRUpper 95% Confidence Interval

Minimum Required Sample SizeOversampling Rate

Denominator

Numerator Events by Medical Record

Records Excluded because of Valid Data Errors

Numerator events by admin data in FSS





Reported RateLower 95% Confidence Interval


Admin Rate on FSS

Data Elements


Final Sample Size (FSS)

Numerator Events by Admin Data on Eligible Population (before exclusions)Current Year's Admin Rate

Measurement Year


Effectiveness of CareChlamydia Screening in Women


General Measure

DataAges 16-20 Ages 21-25

General Measure

DataAges 16-20 Ages 21-25

2006A

338 411 749 NR92 113 205 NR

27.22% 27.49% 27.37% NR NR NR22.33% 23.06% 24.11% NR NR NR32.11% 31.93% 30.63% NR NR NR

Total

Commercial Medicaid

Total


Reported RateNumerator Events by Admin Data


Data Elements


Measurement Year



Osteoporosis Management in Women Who had a Fracture

Medicare Advantage MSHO

NR NRNR NRNR NRUpper 95% Confidence Interva

Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence Interval

Measurement Year


Effectiveness of CareControlling High Blood Pressure




2006H

265 1008 1273

0 0 0

0.00% 0.00% 0.00%411

15.00%411

0 0 00.00% 0.00% 0.00%

10

0

1

0

1191 320 4110 0 040 199 239

43.96% 62.19% 58.15%33.21% 56.72% 53.26%54.70% 67.66% 63.04%

Total

Measurement Year

Current Year's Admin RateMinimum Required Sample SizeOversampling Rate

Lower 95% Confidence IntervalUpper 95% Confidence Interval


Denominator

Reported Rate

Numerator Events by Admin DataNumerator Events by Medical Record

Records Added from the OverSample List


Data Elements

Data Collection Methodology (Hybrid)Eligible Member Population


Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSSRecords Excluded because of Valid Data Errors

Numerator Events by Admin Data on Eligible Population (before exclusions)


Effectiveness of Care Sanford Health PlanBeta Blocker Treatment after Heart Attack Data Last Refreshed:

Oct 7, 2009 1:21 PM


2006H21

18

85.71% NR NR21

0.00%21

1885.71% NR NR

0

0

0

0

021182

NA NR NRNA NR NRNA NR NR

Final Sample Size (FSS)Numerator events by admin data in FSS

Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data on Eligible Population

Current Year's Admin Rate

Measurement Year





Admin rate on FSS


Upper 95% Confidence IntervalLower 95% Confidence IntervalReported Rate


Denominator



Effectiveness of Care Sanford Health PlanPersistence of Beta Blocker Treatment After Hearth Attack Data Last Refreshed:

Oct 7, 2009 1:21 PM


2006A18

10

NA NR NRNA NR NRNA NR NRUpper 95% Confidence Interval

Lower 95% Confidence IntervalReported Rate

Measurement Year

Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data on Eligible Population





Data

LDL-C screening

LDL-C Level of <100 mg/dL

2006H

120

91 17

75.83% 14.17%120

0.00%120

91 1775.83% 14.17%

4

2

0

0

0114

91 178 52

86.84% 60.53%80.20% 51.11%93.49% 69.94%Upper 95% Confidence Interval


Data Elements


Measurement Year



Admin rate on FSS

Final Sample Size (FSS)



Numerator Events by Admin Data on Eligible Population



Records Added from the Oversample ListDenominator

Numerator events by admin data in FSS


Reported RateNumerator Events by Medical Record




Medicare AdvantageGeneral Measure

Data

LDL-C screening


NR NR

NR NR

NR NRNR NRNR NR


Records Added from the Oversample ListDenominatorNumerator Events by Admin DataNumerator Events by Medical Record






Eligible Member PopulationNumerator Events by Admin Data on Eligible PopulationCurrent Year's Admin RateMinimum Required Sample Size

Data Elements

Measurement YearData Collection Methodology




MSHOGeneral Measure

Data

LDL-C screening


NR NR

NR NR

NR NRNR NRNR NR


Numerator Events by Admin DataNumerator Events by Medical RecordReported Rate


Number of employee/dependent medical records excludedRecords Added from the Oversample ListDenominator

Admin rate on FSS



Minimum Required Sample SizeOversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSS

Eligible Member PopulationNumerator Events by Admin Data on Eligible PopulationCurrent Year's Admin Rate

Data Elements

Measurement YearData Collection MethodologySampling Method Used


Effectiveness of Care Sanford Health PlanComprehensive Diabetes Care Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

HbA1c Testing

Poor HbA1c Control

Good HbA1c Control Eye Exam LDL-C

ScreeningLDL-C Level <100 mg/dL

Monitoring for Diabetic

Nephropathy

Blood Pressure

<140/90 mm Hg

Blood Pressure

<130/80 mm Hg

2006 2006 2006 2006 2006 2006 2006 2006 2006H H H H H H H H H

730 730 730 730 730 730 730 730 730

341 730 21 202 294 47 4 0 046.71% 100.00% 2.88% 27.67% 40.27% 6.44% 0.55% 0.00% 0.00%

411 411 411 411 411 411 411 411 41115% 15% 15% 15% 15% 15% 15% 15% 15%411 411 411 411 411 411 411 411 411341 411 21 202 294 47 4 0 0

82.97% 100.00% 5.11% 49.15% 71.53% 11.44% 0.97% 0.00% 0.00%

17 17 17 17 17 17 17 17 17

0 0 0 0 0 0 0 0 0

11 11 11 11 11 11 11 11 11

0 0 0 0 0 0 0 0 0

28 28 28 28 28 28 28 28 28411 411 411 411 411 411 411 411 411341 1 21 202 294 47 4 0 032 87 169 34 29 115 334 266 144

90.75% 21.41% 46.23% 57.42% 78.59% 39.42% 82.24% 64.72% 35.04%87.83% 17.32% 41.29% 52.52% 74.50% 34.57% 78.42% 59.98% 30.30%93.68% 25.50% 51.17% 62.32% 82.68% 44.26% 86.06% 69.46% 39.77%

DenominatorNumerator Events by Admin DataNumerator Events by Medical RecordReported Rate

Numerator events by admin data in FSSAdmin rate on FSSNumber of Records Excluded Because of Valid Data Errors

Additional Records Added from the Oversample List




Minimum Required Sample SizeOversampling RateFinal Sample Size (FSS)

Data Elements

Measurement Year

Eligible Member PopulationData Collection Methodology

Numerator events by admin data in eligible populationCurrent Year's Administrative Rate




Oct 7, 2009 1:21 PM

Medicare Advantage

HbA1c Testing

Poor HbA1c Control




Nephropathy

Blood Pressure

<140/90 mm Hg

Blood Pressure

<130/80 mm Hg



NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR

Data Elements

Measurement Year

Lower 95% Confidence IntervalReported Rate

Number of employee/dependent medical records excludedAdditional Records Added from the Oversample ListDenominatorNumerator Events by Admin DataNumerator Events by Medical Record



Admin rate on FSS

Oversampling Rate

Current Year's Administrative RateMinimum Required Sample Size

Numerator events by admin data in FSSFinal Sample Size (FSS)



Eligible Member PopulationNumerator events by admin data in eligible population




Oct 7, 2009 1:21 PM

MSHO

HbA1c Testing

Poor HbA1c Control




Nephropathy

Blood Pressure

<140/90 mm Hg

Blood Pressure

<130/80 mm Hg








Number of employee/dependent medical records excludedAdditional Records Added from the Oversample List

Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSSNumber of Records Excluded Because of Valid Data Errors

Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample SizeOversampling Rate


Data Elements

Measurement Year




Oct 7, 2009 1:21 PM

Medicaid

HbA1c Testing

Poor HbA1c Control




Nephropathy

Blood Pressure

<140/90 mm Hg

Blood Pressure

<130/80 mm Hg




Numerator Events by Medical RecordReported Rate

Admin rate on FSSNumber of Records Excluded Because of Valid Data ErrorsNumber of administrative data records excluded




Number of employee/dependent medical records excludedAdditional Records Added from the Oversample ListDenominatorNumerator Events by Admin Data

Final Sample Size (FSS)Numerator events by admin data in FSS

Eligible Member PopulationNumerator events by admin data in eligible populationCurrent Year's Administrative Rate

Data Elements

Measurement YearData Collection Methodology


Effectiveness of Care Sanford Health PlanUse of Appropriate Medications for People with Asthma Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

General Measure Data Ages 5-9 Ages 10-17 Ages 18-56

2006A

28 40 143 21128 37 120 185NA 92.50% 83.92% 87.68%NA 83.09% 77.54% 83.01%NA 100.00% 90.29% 92.35%

Measurement Year

Total


Data Elements


Numerator Events by Admin DataEligible Member Population


Effectiveness of Care Sanford Health PlanUse of Appropriate Medications for People with Asthma Data Last Refreshed:

Oct 7, 2009 1:21 PM

Medicaid

General Measure Data Ages 5-9 Ages 10-17 Ages 18-56

NRNR

NR NR NR NRNR NR NR NRNR NR NR NRUpper 95% Confidence Interval

Measurement Year

Numerator Events by Admin DataReported RateLower 95% Confidence Interval

Data Elements Total



Effectiveness of Care Sanford Health PlanAntidepressant Medication Management Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

General Measure

Data

Optimal Practitioner Contacts for Medication

Management

Effective Acute Phase

Treatment

Effective Continuation

Phase Treatment

2006A63

11 49 3817.46% 77.78% 60.32%7.29% 66.72% 47.44%

27.63% 88.84% 73.19%

Measurement Year

Reported Rate

Data Elements






Oct 7, 2009 1:21 PM

Medicare Advantage

General Measure

Data


Management


Treatment


Phase Treatment


Measurement Year


Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data



Oct 7, 2009 1:21 PM

MSHO

General Measure

Data


Management


Treatment


Phase Treatment


Measurement Year


Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported Rate



Oct 7, 2009 1:21 PM

Medicaid

General Measure

Data


Management


Treatment


Phase Treatment


Measurement Year



Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data



Follow-Up Care for Children PrescribedAttention-Deficit/Hyperactivity Disorder (ADHD) Medication

General Measure

Data

Initiation Phase

Continuation and

Maintenance Phase

General Measure

Data

Initiation Phase

Continuation and

Maintenance Phase

2006A

35 51 0

10 328.57% NA NR NR12.18% NA NR NR44.97% NA NR NR

Medicaid

Upper 95% Confidence Interva

Data Elements


Numerator Events by Admin DataReported RateLower 95% Confidence Interval

Total Exclusions

Measurement Year

Commercial


Effectiveness of Care Sanford Health PlanGlaucoma Screening in Older Adults Data Last Refreshed:

Oct 7, 2009 1:21 PM

Medicare Advantage MSHO

NR NRNR NRNR NR

Measurement Year

Upper 95% Confidence Interva

Data Elements

Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence Interval


Effectiveness of Care Sanford Health PlanData Last Refreshed:

Oct 7, 2009 1:21 PMAnnual Monitoring for Patients on PersistenMedications

Commercial

ACE Inhibitors or ARBs Digoxin Diuretics Anti-

convulsants Total

2006A

1211 23 823 56 21130 0 0 0 0

821 14 586 36 145767.80% NA 71.20% 64.29% 68.95%65.12% NA 68.05% 50.84% 66.96%70.47% NA 74.36% 77.73% 70.95%

Total Exclusions

Annual Monitoring for Members onGeneral Measure

DataData Elements

Measurement Year

Reported Rate







Medicare Advantage


convulsants Total

NR NR NR NR NRNR NR NR NR NRNR NR NR NR NR

Total Exclusions

General Measure

Data

Annual Monitoring for Members on

Measurement Year

Data Elements







MSHO


convulsants Total


Total Exclusions

Data ElementsGeneral Measure

Data


Measurement Year




Reported Rate





Medicaid


convulsants Total


Total Exclusions

General Measure

Data


Measurement Year

Data Elements






Effectiveness of Care Sanford Health PlanDrugs to Be Avoided in the Elderly Data Last Refreshed:

Oct 7, 2009 1:21 PM

General Measure

Data

1 or More Prescriptions


General Measure

Data




MSHO

Data Elements




Measurement Year

Reported Rate

Medicare Advantage


Effectiveness of Care Sanford Health PlanPotentially Harmful Drug-Disease Interactions in the Elderly Data Last Refreshed:

Oct 7, 2009 1:21 PM

Medicare Advantage

History of Falls + Tricyclic

Antidepressants, Antipsychotics or

Sleep Agents

Dementia + Tricyclic

Antidepressants orAnticholinergic

Agents

Chronic Renal Failure +

Nonaspirin NSAIDsor Cox-2 Selective

NSAIDs

Total


Drug-Disease Interactions





General Measure

Data


Data Elements

Measurement Year


Effectiveness of Care Sanford Health PlanPotentially Harmful Drug-Disease Interactions in the Elderly Data Last Refreshed:

Oct 7, 2009 1:21 PM

MSHO

History of Falls + Tricyclic

Antidepressants, Antipsychotics or

Sleep Agents

Dementia + Tricyclic

Antidepressants orAnticholinergic

Agents

Chronic Renal Failure +

Nonaspirin NSAIDsor Cox-2 Selective

NSAIDs

Total


Data ElementsGeneral Measure

Data

Drug-Disease Interactions

Numerator Events by Admin DataEligible Member Population


Measurement Year

Reported Rate




Use of Services Sanford Health PlanWell Child Visits in the First 15 Months of Life Data Last Refreshed:

Oct 7, 2009 1:21 PM


DataZero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more

visits

2006A

210

NR NR NR NR NR NR NR


3 2 4 8 11 50 132

1.43% 0.95% 1.90% 3.81% 5.24% 23.81% 62.86%0.00% 0.00% 0.00% 0.98% 1.99% 17.81% 56.08%3.27% 2.50% 3.99% 6.64% 8.49% 29.81% 69.63%





Additional Records Added from the Oversample ListDenominator

Number of records excluded because of contraindications identified through medical record review

Number of records excluded because of contraindications identified through administrative data

Numerator events by admin data in eligible population

Minimum Required Sample SizeCurrect Year's Administrative Rate

Oversampling Rate

Data Elements


Measurement Year



Reported Rate

Final sample size (FSS)Numerator events by admin data in FSS


Use of Services Sanford Health PlanWell Child Visits in the First 15 Months of Life Data Last Refreshed:

Oct 7, 2009 1:21 PM


DataZero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more

visits



NR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NR





Additional Records Added from the Oversample List

Number of records excluded because of contraindications identified through administrative data

Number of records excluded because of contraindications identified through medical record review

Oversampling RateFinal sample size (FSS)Numerator events by admin data in FSSAdministrative rate on FSS

Numerator events by admin data in eligible populationCurrect Year's Administrative RateMinimum Required Sample Size

Data Elements


Measurement Year


Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM

Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life


A1157

NR NR

NR NR

541

46.76% NR43.84% NR49.68% NR

Oversampling Rate

Denominator









Records Excluded - Contraindications/Medical Record Review

Records Excluded - Contraindications/Admin Data

Current Year's Admin RateMinimum Required Sample Size

Data Elements


Measurement Year


Use of Services Sanford Health PlanAdolescent Well-Care Visits Data Last Refreshed:

Oct 7, 2009 1:21 PM


A3280

NR NR

NR NR

870

26.52% NR25.00% NR28.05% NR


Records Excluded - Contraindications/Medical Record Review

Oversampling Rate





Numerator Events by Medical Record

Number of employee/dependent medical records excludedRecords Added from the Oversample ListDenominator

Records Excluded - Contraindications/Admin Data



Minimum Required Sample Size

Data Elements


Measurement Year


Use of Services Sanford Health PlanFrequency of Selected Procedures Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Age0-40-95-1910-19

Procedure AgeNumber of

Procedures0-4 154 6.905-19 23 0.320-9 38 0.8510-19 24 0.48

Age Male Female15-44 7609820-44 61686 6348030-64 8606245-64 47130 4958565+ 1828 1398


ProceduresNumber of

Procedures15-44 19 0.2545-64 14 0.2815-44 21 0.2845-64 23 0.4665+ 0 0.0015-44 19 0.2545-64 32 0.6565+ 0 0.0030-64 1 0.0115-44 1 0.0145-64 6 0.1265+ 0 0.00 0 0.0030-64 28 0.3315-44 54 0.7145-64 26 0.5265+ 0 0.00 0 0.0020-44 52 0.84 103 1.6245-64 109 2.31 131 2.6465+ 2 1.09 4 2.8645-64 41 0.87 7 0.1465+ 0 0.00 0 0.0045-64 50 1.06 37 0.7565+ 7 3.83 0 0.0045-64 12 0.25 0 0.0065+ 0 0.00 0 0.0045-64 13 0.2865+ 1 0.5515-44 2 0.0345-64 7 0.1465+ 2 1.4315-44 15 0.2045-64 24 0.4865+ 0 0.00

Member Months

Female

Member MonthsTotal22326447697262250179

Male

Procedures / 1,000 Member

Months


Months

Total


Months

Lumpectomy

Cholecystectomy, Open

Back Surgery

Mastectomy

Cardiac Catheterization

Prostatectomy

CABG

Myringotomy

Tonsillectomy

Dilation & Curettage

Angioplasty (PTCA)

Hysterectomy, Abdominal

Hysterectomy, Vaginal

Cholecystectomy, Closed



Oct 7, 2009 1:21 PM

Medicare Advantage

Age Male Female< 6565-7475-8485+


ProceduresNumber of

ProceduresCABG <65 NR NR

65-74 NR NR75-84 NR NR85+ NR NR

Angioplasty <65 NR NR(PTCA) 65-74 NR NR

75-84 NR NR85+ NR NR

Cardiac <65 NR NRCatheterization 65-74 NR NR


Carotid <65 NR NREndarterectomy 65-74 NR NR


Reduction of <65 NR NRFracture of Femur 65-74 NR NR


Total Hip <65 NR NRReplacement 65-74 NR NR


Total Knee <65 NR NRReplacement 65-74 NR NR


Partial Excision of <65 NR NRLarge Inestine 65-74 NR NR


Cholecystectomy, <65 NR NROpen 65-74 NR NR


Cholecystectomy, <65 NR NRClosed 65-74 NR NR(laparoscopic) 75-84 NR NR

85+ NR NRBack Surgery <65 NR NR

65-74 NR NR75-84 NR NR85+ NR NR

Hysterectomy <65 NRAbdominal 65-74 NR

75-84 NR85+ NR

Hysterectomy, <65 NRVaginal 65-74 NR

75-84 NR85+ NR

Mastectomy <65 NR65-74 NR75-84 NR85+ NR

Lumpectomy <65 NR65-74 NR75-84 NR85+ NR

Male Female


Months


Months

Member Months



Oct 7, 2009 1:21 PM

MSHO

Age Male Female< 6565-7475-8485+


ProceduresNumber of

ProceduresCABG <65 NR NR

65-74 NR NR75-84 NR NR85+ NR NR

Angioplasty <65 NR NR(PTCA) 65-74 NR NR


Cardiac <65 NR NRCatheterization 65-74 NR NR


Carotid <65 NR NREndarterectomy 65-74 NR NR


Reduction of <65 NR NRFracture of Femur 65-74 NR NR


Total Hip <65 NR NRReplacement 65-74 NR NR


Total Knee <65 NR NRReplacement 65-74 NR NR


Partial Excision of <65 NR NRLarge Inestine 65-74 NR NR


Cholecystectomy, <65 NR NROpen 65-74 NR NR


Cholecystectomy, <65 NR NRClosed 65-74 NR NR(laparoscopic) 75-84 NR NR

85+ NR NRBack Surgery <65 NR NR

65-74 NR NR75-84 NR NR85+ NR NR

Hysterectomy <65 NRAbdominal 65-74 NR

75-84 NR85+ NR

Hysterectomy, <65 NRVaginal 65-74 NR

75-84 NR85+ NR

Mastectomy <65 NR65-74 NR75-84 NR85+ NR

Lumpectomy <65 NR65-74 NR75-84 NR85+ NR

Member Months

Male Female


Months


Months


Use of ServicesInpatient Utilization - General Hospital/Acute Care

nford Health PlanData Last Refreshed:

Oct 7, 2009 1:21 PM

CommercialAge Member Months<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0

320055

Age Discharges Days

Total Inpatient<1 53 12.31 195 45.28 3.681-9 86 2.13 255 6.30 2.9710-19 70 1.40 211 4.20 3.0120-44 756 6.04 2097 16.75 2.7745-64 627 6.48 2264 23.41 3.6165-74 21 6.79 60 19.39 2.8675-84 3 25.21 8 67.23 2.6785+ 0 0.00 0 0.00 NAUnknown 0 0 NA

1616 5.05 5090 15.90 3.15Medicine<1 47 10.91 156 36.22 3.321-9 70 1.73 185 4.57 2.6410-19 29 0.58 85 1.69 2.9320-44 134 1.07 381 3.04 2.8445-64 274 2.83 971 10.04 3.5465-74 12 3.88 34 10.99 2.8375-84 3 25.21 8 67.23 2.6785+ 0 0.00 0 0.00 NAUnknown 0 0 NA

569 1.78 1820 5.69 3.20Surgery<1 6 1.39 39 9.06 6.501-9 16 0.40 70 1.73 4.3810-19 25 0.50 88 1.75 3.5220-44 151 1.21 526 4.20 3.4845-64 353 3.65 1293 13.37 3.6665-74 9 2.91 26 8.40 2.8975-84 0 0.00 0 0.00 NA85+ 0 0.00 0 0.00 NAUnknown 0 0 NA

560 1.75 2042 6.38 3.65Maternity10-19 16 0.32 38 0.76 2.3820-44 471 3.76 1190 9.51 2.5345-64 0 0.00 0 0.00 NAUnknown 0 0 NA

487 1.79 1228 4.51 2.52

Days / 1,000 Member Months

Average Length of Stay

Total

Total

Total

Total

Total

Discharges / 1,000 Member

Months




Oct 7, 2009 1:21 PM

Medicare AdvantageAge Member Months<11-910-1920-4445-6465-7475-8485+Unknown

NR

Age Discharges Days

Total Inpatient<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRMedicine<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRSurgery<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRMaternity10-19 NR NR NR20-44 NR NR NR45-64 NR NR NRUnknown NR

NR NR NR NR NR



Months


Total

Total

Total

Total

Total




Oct 7, 2009 1:21 PM

MSHOAge Member Months<11-910-1920-4445-6465-7475-8485+Unknown

NR

Age Discharges Days

Total Inpatient<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRMedicine<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRSurgery<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NRMaternity10-19 NR NR NR20-44 NR NR NR45-64 NR NR NRUnknown NR

NR NR NR NR NR



Total


Months

Total

Total

Total

Total


Use of ServicesAmbulatory Care

nford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM

Commercial

AgeMember Months

<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0

320055

Outpatient Visits (Excludes MH/CD)

Emergency Room Visits

Age Visits Visits Procedures Stays<1 3969 921.52 112 26.00 38 8.82 22 5.111-9 11475 283.60 569 14.06 166 4.10 34 0.8410-19 9636 192.03 565 11.26 190 3.79 42 0.8420-44 27044 216.07 1261 10.07 826 6.60 140 1.1245-64 28432 293.98 769 7.95 1680 17.37 125 1.2965-74 1181 381.58 34 10.99 68 21.97 9 2.9175-84 82 689.08 2 16.81 3 25.21 0 0.0085+ 0 0.00 0 0.00 0 0.00 0 0.00Unknown 0 0 0 0

81819 255.64 3312 10.35 2971 9.28 372 1.16

Ambulatory Surgery/Procedures

Total

Total

Stays/ 1,000 Member Months

Observation Room Stays Resulting in Discharge

Visits/ 1,000 Member Months


Procedures/ 1,000 Member

Months




Medicare Advantage

AgeMember Months

<11-910-1920-4445-6465-7475-8485+Unknown

NR



Age Visits Visits Procedures Stays<1 NR NR NR NR1-9 NR NR NR NR10-19 NR NR NR NR20-44 NR NR NR NR45-64 NR NR NR NR65-74 NR NR NR NR75-84 NR NR NR NR85+ NR NR NR NRUnknown

NR NR NR NR NR NR NR NR




Months

Total




Total




MSHO

AgeMember Months

<11-910-1920-4445-6465-7475-8485+Unknown

NR



Age Visits Visits Procedures Stays<1 NR NR NR NR1-9 NR NR NR NR10-19 NR NR NR NR20-44 NR NR NR NR45-64 NR NR NR NR65-74 NR NR NR NR75-84 NR NR NR NR85+ NR NR NR NRUnknown

NR NR NR NR NR NR NR NRTotal

Total






Months



Use of Services Sanford Health PlanInpatient Utilization - Nonacute Care Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

AgeMember Months

<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0

320055

<1 0 0.00 0 0.00 NA1-9 0 0.00 0 0.00 NA10-19 0 0.00 0 0.00 NA20-44 8 0.06 46 0.37 5.7545-64 33 0.34 432 4.47 13.0965-74 0 0.00 0 0.00 NA75-84 0 0.00 0 0.00 NA85+ 0 0.00 0 0.00 NAUnknown 0 0 NA

41 0.13 478 1.49 11.66

Total

Total

Age


MonthsDischarges DaysAverage Length

of Stay




Oct 7, 2009 1:21 PM

Medicare Advantage

AgeMember Months

<11-910-1920-4445-6465-7475-8485+Unknown

NR

<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NR

Total

Total

DaysDischarges


MonthsAge


Average Lengthof Stay



Oct 7, 2009 1:21 PM

MSHO

AgeMember Months

<11-910-1920-4445-6465-7475-8485+Unknown

NR

<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR

NR NR NR NR NR

Days



Total

Total

Age Discharges


Months




Commercial

Age Male Female0-12 30602 28336 5893813-17 13328 12896 2622418-64 113723 117944 23166765+ 1828 1398 3226Unknown 0 0 0

159481 160574 320055

Age GenderDischarges Days*

M 6 0.20 48 8.00F 1 0.04 16 16.00

7 0.12 64 9.14M 4 0.30 19 4.75F 14 1.09 189 13.50

18 0.69 208 11.56M 36 0.32 147 4.08F 46 0.39 243 5.28

82 0.35 390 4.76M 0 0.00 0 NAF 0 0.00 0 NA

0 0.00 0 NAM 0 0 NAF 0 0 NA

0 0 NA46 0.29 214 4.6561 0.38 448 7.34107 0.33 662 6.19

Unknown

Total

65+


Total

Total

Total

Total

Total

TotalMFTOTAL

Member Months

0-12

13-17

18-64

Total


Months




Medicare Advantage

Age Male Female0-12 NR13-17 NR18-64 NR65+ NRUnknown NR

NR NR NR


M NR NRF NR NR

NR NR NR NRM NR NRF NR NR



NR NR NR NRM NRF NR

NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR


18-64

Total

0-12

Total13-17

Total

Total MFTOTAL

Unknown

Total

65+

Total


Months

Member Months

Total

Total




MSHO


NR NR NR


M NR NRF NR NR




NR NR NR NRM NRF NR


Unknown

Total

18-64

Total65+

Total

0-12

Total

Total MFTOTAL

13-17

Total

Total

Total


Months


Member Months


Use of Services Sanford Health PlanData Last Refreshed:

Oct 7, 2009 1:21 PMMental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory

Commercial

Age Male Female Male Female Male Female Male Female0-12 30602 28336 58938 30602 28336 58938 30602 28336 58938 30602 28336 5893813-17 13328 12896 26224 13328 12896 26224 13328 12896 26224 13328 12896 2622418-64 113723 117944 231667 113723 117944 231667 113723 117944 231667 113723 117944 23166765+ 1828 1398 3226 1828 1398 3226 1828 1398 3226 1828 1398 3226Unknown 0 0 0 0 0 0 0 0 0 0 0 0

159481 160574 320055 159481 160574 320055 159481 160574 320055 159481 160574 320055

Age Sex Number Number Number NumberM 94 3.69% 5 0.20% 0 0.00% 94 3.69%F 65 2.75% 1 0.04% 0 0.00% 65 2.75%

159 3.24% 6 0.12% 0 0.00% 159 3.24%M 74 6.66% 4 0.36% 1 0.09% 72 6.48%F 98 9.12% 11 1.02% 1 0.09% 97 9.03%

172 7.87% 15 0.69% 2 0.09% 169 7.73%M 341 3.60% 27 0.28% 7 0.07% 329 3.47%F 584 5.94% 34 0.35% 7 0.07% 573 5.83%

925 4.79% 61 0.32% 14 0.07% 902 4.67%M 1 0.66% 0 0.00% 0 0.00% 1 0.66%F 2 1.72% 0 0.00% 0 0.00% 2 1.72%

3 1.12% 0 0.00% 0 0.00% 3 1.12%M 0 NA 0 NA 0 NA 0 NAF 0 NA 0 NA 0 NA 0 NA

0 NA 0 NA 0 NA 0 NA510 3.84% 36 0.27% 8 0.06% 496 3.73%749 5.60% 46 0.34% 8 0.06% 737 5.51%1259 4.72% 82 0.31% 16 0.06% 1233 4.62%

Member Months (Day/Night) Member Months (Ambulatory)

Any Mental Health Services Inpatient Mental Health Services

TotalTotal

Unknown

Total

0-12

13-17

18-64

65+

Percent Percent PercentDay/Night Mental Health Services Ambulatory Mental Health Services

Total

Total

Total

Total

Total

Total

Member Months (Any)

MFTotal

Total Total

Percent

Member Months (Inpatient)




Medicare Advantage

Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR

NR NR NR NR NR NR NR NR NR NR NR NR

Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR

NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR




NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR

Ambulatory Mental Health ServicesPercent Percent Percent

Member Months (Inpatient)

Percent

Total

Total

Total


Any Mental Health Services Inpatient Mental Health Services Day/Night Mental Health Services

TotalTotalTotal TotalMember Months (Any)

65+

TotalUnknown

TotalF

Total

Total

M

18-64

0-12

13-17

Total




MSHO









Unknown

TotalTotal M

FTotal

18-64

Total65+

Total

0-12

Total13-17

Total

Ambulatory Mental Health ServicesPercent Percent Percent Percent

Total

Any Mental Health Services Inpatient Mental Health Services Day/Night Mental Health Services

Total Total Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)




Medicaid









13-17

Total

Day/Night Mental Health Services Ambulatory Mental Health ServicesPercent Percent

Unknown

Total

18-64

Total65+

Total

Total MFTotal

Percent PercentAny Mental Health Services Inpatient Mental Health Services

0-12

Total

Total Total

Total

Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)



Chemical Dependency Utilization - Inpatient Discharges and Average Length of

Commercial

Age Male Female0-12 30602 28336 5893813-17 13328 12896 2622418-64 113723 117944 23166765+ 1828 1398 3226Unknown 0 0 0

159481 160574 320055

AgeDischarges Days

M 0 0.00 0 NAF 0 0.00 0 NA

0 0.00 0 NAM 3 0.23 56 18.67F 9 0.70 93 10.33

12 0.46 149 12.42M 29 0.26 422 14.55F 12 0.10 104 8.67

41 0.18 526 12.83M 0 0.00 0 NAF 0 0.00 0 NA

0 0.00 0 NAM 0 0 NAF 0 0 NA

0 0 NA32 0.20 478 14.9421 0.13 197 9.3853 0.17 675 12.74

Total

TotalMember Months

65+

18-64

TotalMTotalF

Unknown

TOTAL

0-12

Total

Total

13-17


Months


Total

Total




Medicare Advantage


NR NR NR

AgeDischarges Days

M NR NRF NR NR




NR NR NR NRM NRF NR



0-12

Total

Member MonthsTotal

Total

Total18-64

Total


Months

Total MFTOTAL

65+

TotalUnknown

Total

13-17




MSHO


NR NR NR

AgeDischarges Days

M NR NRF NR NR




NR NR NR NRM NRF NR


Unknown

TotalTotal M

FTOTAL

18-64

Total65+

Total


0-12

Total13-17

Total

Member MonthsTotal

Total


Months


Use of ServicesIdentification of Alcohol and Other Drug Services

Sanford Health PlanData Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Age Male Female Male Female Male Female Male Female0-12 30602 28336 58938 30602 28336 58938 30602 28336 58938 30602 28336 5893813-17 13328 12896 26224 13328 12896 26224 13328 12896 26224 13328 12896 2622418-24 15702 15725 31427 15702 15725 31427 15702 15725 31427 15702 15725 3142725-34 23715 24495 48210 23715 24495 48210 23715 24495 48210 23715 24495 4821035-64 74306 77724 152030 74306 77724 152030 74306 77724 152030 74306 77724 15203065+ 1828 1398 3226 1828 1398 3226 1828 1398 3226 1828 1398 3226Unknown 0 0 0 0 0 0 0 0 0 0 0 0

159481 160574 320055 159481 160574 320055 159481 160574 320055 159481 160574 320055

Age Sex Number Number Number NumberM 0 0.00% 0 0.00% 0 0.00% 0 0.00%F 0 0.00% 0 0.00% 0 0.00% 0 0.00%

0 0.00% 0 0.00% 0 0.00% 0 0.00%M 5 0.45% 3 0.27% 1 0.09% 4 0.36%F 10 0.93% 4 0.37% 1 0.09% 6 0.56%

15 0.69% 7 0.32% 2 0.09% 10 0.46%M 16 NR 5 NR 5 NR 9 NRF 7 NR 2 NR 3 NR 4 NR

23 NA 7 NA 8 NA 13 NAM 20 0.78% 7 0.27% 4 0.16% 13 0.51%F 3 0.13% 0 0.00% 0 0.00% 3 0.13%

23 0.47% 7 0.14% 4 0.08% 16 0.33%M 42 0.68% 15 0.24% 11 0.18% 27 0.44%F 14 0.22% 8 0.12% 1 0.02% 8 0.12%

56 0.44% 23 0.18% 12 0.09% 35 0.28%M 0 0.00% 0 0.00% 0 0.00% 0 0.00%F 0 0.00% 0 0.00% 0 0.00% 0 0.00%

0 0.00% 0 0.00% 0 0.00% 0 0.00%M 0 NA 0 NA 0 NA 0 NAF 0 NA 0 NA 0 NA 0 NA

0 NA 0 NA 0 NA 0 NA83 0.62% 30 0.23% 21 0.16% 53 0.40%34 0.25% 14 0.10% 5 0.04% 21 0.16%

117 0.44% 44 0.16% 26 0.10% 74 0.28%

13-17

Total

Total25-34

Total

Any Chemical Dependency Services Inpatient Chemical Dependency Services

Day/Night Chemical Dependency Services

Member Months (Any) Member Months (Inpatient)Total Total


Ambulatory Chemical Dependency Services

35-64

65+

F

18-24

Total

Total

0-12Percent Percent Percent Percent

Unknown

Total

Total

Total

Total

Total

Total

TotalM




Oct 7, 2009 1:21 PM

Medicare Advantage

Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-24 NR NR NR NR25-34 NR NR NR NR35-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR










0-12

Total

Total


TotalTotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)

Total

Percent

Total

Percent

Day/Night Chemical Dependency ServicesAny Chemical Dependency Services Inpatient Chemical Dependency

ServicesPercent Percent

13-17

Total

65+

Total

18-24

Total25-34

Total35-64

Total

Unknown

TotalTotal M

FTotal




Oct 7, 2009 1:21 PM

MSHO











Total

65+

Total

Inpatient Chemical Dependency Services



Percent Percent Percent Percent

Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)Total Total Total Total

25-34

Total

Member Months (Any)

Total

Any Chemical Dependency Services

0-12

Total13-17

18-24

Total

35-64

Total

Unknown

TotalTotal M

FTotal




Oct 7, 2009 1:21 PM

Medicaid











Total MFTotal

65+

TotalUnknown

Total

0-12

Total13-17

Total


Percent Percent Percent Percent

Total

Any Chemical Dependency Services Inpatient Chemical Dependency Services


Total Total Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)

18-24

Total25-34

Total35-64

Total


Use of Services Sanford Health PlanOutpatient Drug Utilization Data Last Refreshed:

Oct 7, 2009 1:21 PM

CommercialAge Member Months0-9 4476910-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0

320055Age

Total Cost of Prescriptions

Total Number of Prescriptions

0-9 $678,531.11 $15.16 14476 3.8810-19 $1,064,167.27 $21.21 16356 3.9120-44 $3,817,318.29 $30.50 70860 6.7945-64 $7,067,341.17 $73.07 123011 15.2665-74 $326,369.54 $105.45 6021 23.3475-84 $18,921.29 $159.00 320 32.2785+ $392.45 $32.70 8 8.00Unknown $0.00 0

$12,973,041.12 $40.53 231052 8.66

Avg. Cost of Prescriptions /

Per Member Per Month

Avg. Num. Of Prescriptions /

Per Member Per Year

Total

Total



Oct 7, 2009 1:21 PM

Medicare AdvantageAge Member Months0-910-1920-4445-6465-7475-8485+Unknown

NRAge



0-9 NR NR10-19 NR NR20-44 NR NR45-64 NR NR65-74 NR NR75-84 NR NR85+ NR NRUnknown

NR NR NR NR




Per Member Per Year

Total

Total



Oct 7, 2009 1:21 PM

MSHOAge Member Months0-910-1920-4445-6465-7475-8485+Unknown

NRAge




NR NR NR NR

Total




Per Member Per Year

Total



Oct 7, 2009 1:21 PM

MedicaidAge Member Months0-910-1920-4445-6465-7475-8485+Unknown

NRAge




NR NR NR NR

Total




Per Member Per Year

Total


Access/Availability of Care Sanford Health PlanAdult's Access to Preventive/Ambulatory Health Services Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Data Elements General Measure Data Ages 20-44 Ages 45-64 Ages 65+

Measurement Year 2006

Data collection methodology (Administrativonly) A

Eligible member population (i.e. members who meet all denominator criteria) 3447 4251 196

Numerator events by administrative data 3253 4032 19294.37% 94.85% 97.96%93.59% 94.17% 95.72%95.16% 95.52% 100.00%

Reported rateLower 95% confidence intervalUpper 95% confidence interval



Oct 7, 2009 1:21 PM

Medicare Advantage


Measurement Year

Data collection methodology (Administrativonly)Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data


Lower 95% confidence intervalUpper 95% confidence interval

Reported rate



Oct 7, 2009 1:21 PM

MSHO


Measurement Year






Oct 7, 2009 1:21 PM

Medicaid


Measurement Year


NR NR NRNR NR NRNR NR NRUpper 95% confidence interval

Reported rateLower 95% confidence interval


Access/Availability of Care Sanford Health PlanChildren's and Adolescents' Access to Primary Care Practitioners Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Data Elements General Measure Data 12-24 months

25 months - 6 yrs. 7-11 yrs. 12-19 yrs.


Data collection methodology (Administrativonly) A

Eligible member population (i.e. members who meet all denominator criteria) 306 1444 1093 2004

Numerator events by administrative data 303 1275 944 176299.02% 88.30% 86.37% 87.92%97.75% 86.60% 84.29% 86.47%

100.00% 89.99% 88.45% 89.38%



Access/Availability of Care Sanford Health PlanChildren's and Adolescents' Access to Primary Care Practitioners Data Last Refreshed:

Oct 7, 2009 1:21 PM

Medicaid

Data Elements General Measure Data 12-24 months

25 months - 6 yrs. 7-11 yrs. 12-19 yrs.

Measurement Year


NR NR NR NRNR NR NR NRNR NR NR NRUpper 95% confidence interval



Access/Availability of Care Sanford Health PlanPrenatal and Postpartum Care Data Last Refreshed:

Oct 7, 2009 1:21 PM

CommercialGeneral

Measure DataTimeliness of Prenatal Care

Postpartum Care

Data collection methodology (Administrative or Hybrid) HEligible member population (i.e. members who meet all denominator criteria) 380

Number of numerator events by administrative data in eligible population (before exclusions) 39 190

10.26% 50.00%

Minimum required sample size (MRSS) or other sample size 260

Oversampling rate 5%Final sample size (FSS) 260

Number of numerator events by administrative data in FSS 39 190

15.00% 73.08%Number of original sample records excluded because of valid data errors 1

Number of administrative data records excluded 0

Number of medical records data records excluded 1

Number of employee/dependent medical records excluded 0

Records added from the oversample list 2Denominator 260Numerator events by administrative data 39 190Numerator events by medical record 206 26

94.23% 83.08%91.20% 78.33%97.26% 87.83%Upper 95% confidence interval





Access/Availability of Care Sanford Health PlanPrenatal and Postpartum Care Data Last Refreshed:

Oct 7, 2009 1:21 PM

MedicaidGeneral

Measure DataTimeliness of Prenatal Care

Postpartum Care

Data collection methodology (Administrative or Hybrid)Eligible member population (i.e. members who meet all denominator criteria)Number of numerator events by administrative data in eligible population (before exclusions)

NR NR

Minimum required sample size (MRSS) or other sample size

Oversampling rateFinal sample size (FSS)

Number of numerator events by administrative data in FSS

NR NRNumber of original sample records excluded because of valid data errors


Number of medical records data records excluded


Records added from the oversample listDenominatorNumerator events by administrative dataNumerator events by medical record

NR NRNR NRNR NRUpper 95% confidence interval





Access/Availability of Care Sanford Health PlanInitiation/Engagement of Alcohol & Other Drug Dependence Treatment Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Data Elements General Measure

Data

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment


Data collection methodology (Administrative only) A

22 1

NA NA NA NA NA NA 31.43% 2.86% NA NA 36.07% 1.64%NA NA NA NA NA NA 14.62% 0.00% NA NA 23.20% 0.00%NA NA NA NA NA NA 48.24% 9.81% NA NA 48.94% 5.65%

0Reported rateLower 95% confidence intervalUpper 95% confidence interval

18-25 Year Olds 26-34 Year Olds 35-64 Year Olds 65+ Year Olds Overall Rate

Eligible member population (i.e. members who meet all denominator criteria) 6 12 35 0 61

13-17 Year Olds

0Numerator events by administrative data 3 0 3 0 11 1

8

5 0



Oct 7, 2009 1:21 PM

Medicare Advantage


Data

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Measurement YearData collection methodology (Administrative only)

NR NR

NR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NR


Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data

65+ Year Olds Overall Rate

NR

18-25 Year Olds 26-34 Year Olds 35-64 Year Olds13-17 Year Olds



Oct 7, 2009 1:21 PM

MSHO


Data

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment


NR NR



Reported rateNumerator events by administrative data

NREligible member population (i.e. members who meet all denominator criteria)

Overall Rate18-25 Year Olds 26-34 Year Olds 35-64 Year Olds 65+ Year Olds13-17 Year Olds



Oct 7, 2009 1:21 PM

Medicaid


Data

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

Treatment


NR NR



Reported rate

NR

Numerator events by administrative data

Eligible member population (i.e. members who meet all denominator criteria)

65+ Year Olds Overall Rate13-17 Year Olds 18-25 Year Olds 26-34 Year Olds 35-64 Year Olds


Health Plan Stability Sanford Health PlanYears in Business / Total Membership Data Last Refreshed:

Oct 7, 2009 1:21 PM

CommercialProduct/Product Line Years in Business Members*

Medicaid 0.00 0Commercial 8.00 27086Medicare (cost or risk) 0.00 0Self-insured 8.00 14309Other 8.00 2436

8.00 43831

Commercial 0.00 0Medicare (cost or risk) 0.00 0Self-insured 0.00 0Other 0.00 0

0.00 0

Commercial 0.00 0Medicare (cost or risk) 0.00 0Self-insured 0.00 0Other 0.00 0

0.00 043831

* Total number of members in each category as of December 31, 2006

Total HMO:

Total PPO:

Total POS: Total:

HMO

PPO

POS



Oct 7, 2009 1:21 PM

Medicare AdvantageProduct/Product Line Years in Business Members*

MedicaidCommercialMedicare (cost or risk)Self-insuredOther

NR NR

CommercialMedicare (cost or risk)Self-insuredOther

NR NR


NR NRNR


Total HMO:

Total POS: Total:

Total PPO:

HMO

PPO

POS



Oct 7, 2009 1:21 PM

MSHOProduct/Product Line Years in Business Members*


NR NR


NR NR


NR NRNR


Total HMO:

Total PPO:

Total POS: Total:

POS

HMO

PPO



Oct 7, 2009 1:21 PM

MedicaidProduct/Product Line Years in Business Members*


NR NR


NR NR


NR NRNR


Total HMO:

Total PPO:

Total POS:

HMO

PPO

POS

Total:


Health Plan Descriptive Information Sanford Health PlanEnrollment by Product Line (Age & Sex) Data Last Refreshed:

Oct 7, 2009 1:21 PM

Commercial

Male Female<1 2100 2208 43081-4 9684 8340 180245-9 11484 10968 2245210-14 12744 11988 2473215-17 7932 7740 1567218-19 4908 4884 9792

48852 46128 9498030.63% 28.73% 29.67%

20-24 10800 10848 2164825-29 11964 12288 2425230-34 11760 12204 2396435-39 12912 13452 2636440-44 14268 14688 28956

61704 63480 12518438.68% 39.53% 39.11%

45-49 15528 15852 3138050-54 14196 14256 2845255-59 10644 12036 2268060-64 6756 7440 14196

47124 49584 9670829.54% 30.88% 30.21%

65-69 1428 1068 249670-74 336 264 60075-79 36 60 9680-84 24 0 2485-89 12 0 12>=90 0 0 0

1836 1392 32281.15% 0.87% 1.01%

Age Unknown 0 0 0159516 160584 320100

Member Months

20-44 Subtotal20-44 Subtotal: %

Total

Total



>=65 Subtotal>=65 Subtotal: %



Oct 7, 2009 1:21 PM

Medicare Advantage

Male Female<1 NR1-4 NR5-9 NR10-14 NR15-17 NR18-19 NR

NR NR NRNR NR NR

20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR

NR NR NRNR NR NR

45-49 NR50-54 NR55-59 NR60-64 NR

NR NR NRNR NR NR

65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR

NR NR NRNR NR NR

Age Unknown NRNR NR NR

Member MonthsTotal





Total



Oct 7, 2009 1:21 PM

MSHO


NR NR NRNR NR NR

20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR

NR NR NRNR NR NR

45-49 NR50-54 NR55-59 NR60-64 NR

NR NR NRNR NR NR

65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR

NR NR NRNR NR NR



Total



Member MonthsTotal




Oct 7, 2009 1:21 PM

Medicaid


NR NR NRNR NR NR

20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR

NR NR NRNR NR NR

45-49 NR50-54 NR55-59 NR60-64 NR

NR NR NRNR NR NR

65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR

NR NR NRNR NR NR


>=65 Subtotal: %

Total

20-44 Subtotal: %


>=65 Subtotal

Total


20-44 Subtotal

Member Months


Documents

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